Knotless tissue anchor

ABSTRACT

There is disclosed a radially expandable knotless tissue anchor including an expandable outer member defining a bore and an inner member slidably positioned within the bore. Relative longitudinal movement of the inner member relative to the expandable member causes a portion of the expandable member to expand radially outwardly. The tissue anchor further includes a length of suture material having a first end affixed to a distal end of the inner member and a second end preferably affixed to a suturing needle. A transverse bore is provided adjacent the distal end of the inner member. There is also disclosed a method of knotlessly anchoring a section of tissue to a section of bone having a bore drilled therethrough. The method includes passing the suture through the tissue and positioning the expandable member and a section of tissue within the interior of the bore drilled in bone. Expansion of the expandable member secures the suture between the expandable member and the bone to thereby secure the attached tissue to bone. There is also disclosed a method of knotlessly securing a section of ligament within an elongated bore drilled in bone. The method includes passing the length of suture through the ligament and drawing the ligament adjacent the distal end of the inner member and wrapping or lashing the ligament to the distally inner member. Distal movement of the expandable member relative to the inner member causes expansion of the expandable member to secure both the suture and the section of ligament between the expandable member and the bone. Additionally, a distal movement of the expandable member forces the lashed sections of suture off the inner member.

BACKGROUND

1. Technical Field

The present disclosure relates to knotless tissue and suture anchorsand, more particularly to radially expandable anchors and methods foruse of the expandable anchors.

2. Background of Related Art

During surgery it is often necessary to attach prosthetic implants orsoft tissue such as muscle tissue, ligaments, or tendons to hard tissuesuch as bone. Various types of surgical fasteners are employed foraccomplishing this function, including staples, screw and washersystems, suture anchoring devices, and tissue anchors.

The first of these types is illustrated in U.S. Pat. Nos. 4,454,875 and4,570,623, which show metal staples with spikes on the underside of thecrosspiece to secure ligaments.

Fasteners included in the second of these types are available asscrew-washer combinations wherein the screw is fabricated from asurgically suitable metal, such as titanium or stainless steel alloy,and is usually of self-tapping design. Suture anchors are adapted to beinserted into predrilled holes in bone and can be made of bioabsorbablematerial. When securing a ligament or suture within a bore drilled inbone, the self-tapping screws may abrade the ligament or suture as theyare threaded in.

Suture anchors are also used to draw tissue adjacent bone. The anchor,having a first end and a suture attached thereto is anchored in bone anda second end of the suture is threaded through tissue and a knot is tiedto secure the tissue to the bone.

Expandable tissue fasteners adapted for use in minimally invasivesurgical procedures (e.g. arthroscopic procedures) are employed, forexample, in the repair of shoulder and knee injuries. In suchprocedures, the operating instrumentation is usually deployed through along, narrow cannula inserted through a small incision in the skin.Knots in the suture are typically tied remotely and pushed down to theanchor to secure the tissue and the site.

What is needed is an expandable tissue fastener or anchor for knotlesslysecuring tissue bone, and for atraumatically securing a graft to bone,especially in minimally invasive surgical procedures.

SUMMARY

What is provided is a knotless tissue anchor including an expandablemember defining a bore therethrough and having a radially expandableportion. The expandable member may also have an enlarged head portion.Preferably the radially expanding portion includes at least two distallyextending legs defining a pair of slots therebetween. The tissue anchorfurther includes an inner member slidably disposed within the bore ofthe expandable member and having a camming surface engageable with thedistal ends of the legs to force the distal ends of the legs radiallyoutwardly in response to the distal movement of the expandable memberrelative to the inner member. The inner member also includes a length ofsuture having a first end affixed to the distal end of the inner memberand a second free end and preferably the second free end is affixed to asurgical needle for passing the suture through tissue. More preferablythe second end of the suture is affixed to a double pointed surgicalneedle or surgical incision member configured to pass the suture throughtissue. Importantly, a distal end of the inner member is provided with atransverse bore of sufficient diameter to allow the surgical needle andsuture to pass therethrough in order to secure tissue or a length ofligament adjacent the distal end of the inner member.

The proximal end of the inner member may be provided with an enlargedhead for engagement and retention within a mounting member associatedwith an implantation apparatus. Furthermore, the inner member may beprovided with a plurality of fins configured to slide within and beguided by the slots defined between the legs of the outer member. Ridgesmay also be provided on a shaft section of the inner member to prevent adistal movement of the inner member relative to the expandable memberafter the legs have been expanded. Finally, the inner member may also beprovided with a breakaway notch such that upon full expansion of thelegs of the expandable member, the notch is severed and a portion of theinner member is broken off to leave the surface of the tissue anchorflush with bone.

There is also provided a mounting member configured to releasablyreceive the disclosed tissue fastener and to be releasably mounted on animplantation apparatus.

There is also disclosed a method of knotlessly securing a section oftissue to a bone. This is particularly advantageous in surgeries such asshoulder, ligament or muscle repair surgery. The method generallyincludes providing the disclosed tissue fastener having an expandableouter member defining a bore and the inner member movably mounted withinthe outer member. Additionally, a length of suture affixed to the distalend of the inner member and having a suturing needle at the opposite endof the suture is also provided. The method further includes the steps ofpassing the free end of the suture through the tissue to be fastened.Preferably, this is accomplished with a suturing instrument utilized topass the surgical needle through the tissue. Thereafter, the tissuefastener, having the section of tissue attached thereto, is positionedwith a bore formed in bone while the section of tissue remains outsidethe bore. Additionally, the length of suture extending from the distalend of the inner member is also positioned in the bore formed in thebone and extending parallel to the tissue fastener and outwardly of thebore. The expandable member is expanded by driving the expandable memberdistally relative to the inner member to thereby expand the expandablemember into engagement with the suture against the bone.

The method may also include the step of passing the free end of thesuture through a transverse bore in a distal end of the inner memberafter the suture has been passed through tissue to secure the tissueadjacent the distal end of the inner member. After the suture has beenpassed through the transverse bore, tension may be applied to the sutureto either draw the tissue adjacent the bore drilled in bone.

There is also disclosed a method of securing a ligament within anelongated bore drilled in bone such as that used in knee repair surgery.Method includes providing the tissue fastener described herein andpiercing the ligament one or more times with the needle attached to thesuture. Thereafter the needle and suture are passed through the hub to atransverse bore in the distal end of an inner member of the tissuefastener and the ligament is snugly secured adjacent the distal end ofthe inner member. Furthermore, the suture may be wrapped several timesabout the ligament and distal end of the inner member thereby securelylashing the ligament to the distal end of the inner member. The tissuefastener is either provided with a mounting portion for attachment to animplantation apparatus or may be manually assembled into a mountingmember which is then releasably mounted into an implantation member.

Once the assembled tissue fastener and ligament have been mounted on theimplantation apparatus, the implantation apparatus may be insertedthrough an enlarged bore formed through a pair of knee bones. The boresare of sufficient diameter that the attached ligament is not abraded ordestroyed as it is advanced through the enlarged bore. Preferably, atthe distal most end of the bores, a reduced diameter section is providedfor receipt of the tissue fastener and associated ligament. Thereafterthe implantation apparatus is actuated to expand the expandable memberthus compressing the ligament adjacent the wall of the bore of the boneto secure the ligament between the expandable member and the bone. Thus,the ligament can be implanted with only radially extending forces actingon the ligament thereby providing atraumatic delivery and securement ofthe ligament within knee bone.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments are described below with reference to the drawingswherein:

FIG. 1 is a perspective view, with parts separated, of a preferredembodiment of a radially expandable tissue fastener including anassociated length of suture and needle and a mounting portion for usewith an implantation device;

FIG. 2 is a cross-sectional view of the assembled tissue fastener in anunfired state;

FIG. 3 is a cross-sectional view of the assembled tissue fastener in theradially expanded fired state;

FIG. 4 is a cross-sectional view of the tissue fastener loaded into themounting portion to form a disposable loading unit;

FIG. 5 is a perspective view of the disposable loading unit mounted on atissue fastener implantation apparatus and the associated needle mountedon a jaw of a suturing apparatus;

FIG. 6 is a side view of the jaws of the suturing apparatus passing theneedle through a section of tissue to be fastened to bone;

FIG. 7 is a side view of the suturing instrument having passed theneedle through a bore in the tissue fastener;

FIG. 8 is a cross-sectional view of the tissue fastener in an unfiredstate, positioned in a bore drilled in bone;

FIG. 9 is a cross-sectional view of the tissue fastener in the boreformed in the bone, in the fired state, to anchor both ends of thesuture therein;

FIG. 10 is a cross-sectional view taken along line 10-10 of FIG. 9;

FIG. 11 is a side view of a piece of ligament or graft material havingbeen penetrated by the needle and suture associated with the tissuefastener;

FIG. 12 is a partial cross-sectional view of the graft material securedto an end of the tissue fastener;

FIG. 13 is a perspective view of the assembled tissue fastener and graftmaterial mounted on the implantation apparatus and positioned in a boredrilled through bone; and

FIG. 14 is a partial cross-sectional view of the expanded tissuefastener securing a first end of the graft material within the bore inthe bone.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The preferred embodiments of the apparatus and methods disclosed hereinare discussed in terms of orthopedic expandable tissue fastenerimplantation. It is also envisioned, however, that the disclosure isapplicable to a wide variety of procedures including, but not limited toligament repair, joint repair or replacement, non-union fractures,facial reconstruction, etc. In addition, it is believed that the presentapparatus finds application in both open and minimally invasiveprocedures including endoscopic and arthroscopic procedures whereinaccess to the surgical site is achieved through a cannula or smallincision.

In the description which follows, the term “proximal”, as istraditional, will refer to the portion of the structure which is closestto the operator, while the term “distal” will refer to the portion whichis furthest from the operator.

The device and methods described herein are specifically configured forsecuring tissue or suture material by applying a radially expandabletissue fastener to a predrilled hole in bone and securing the tissue orsuture between the fastener and the bone. The orthopedic tissue fasteneris preferably provided as part of a disposable loading unit including amounting unit.

Referring now to FIG. 1, tissue fastener 10 includes an expandable body12; and a setting pin. More particularly, body 12 and the setting pinare preferably fabricated from a bioabsorbable material such as polymersof glycolide, lactide, caprolactrone, p-dioxanone, trimethylenecarbonate and physical and chemical combinations thereof. Body 12includes a shaft 14 with an axial aperture 15 extending therethrough. Anenlarged head 16 may be provided at a proximal end of shaft 14 to engagean implantation instrument.

Shaft 14 includes at least two, and preferably four, distally extendinglegs 18 which arc defined by lengthwise slots 20. Body 12 is fabricatedfrom a material with sufficient flexibility and resiliency to allow legs18 to radially expand by splaying outward. When body 12 is placed in ahole and legs 18 are expanded, barbs 22 provided on the outer surface oflegs 18 engage the wall of bone tissue surrounding the hole andfictionally secure the body therein. Expanded legs 18 also knotlesslysecure a section of suture or graft material positioned between legs 18and adjacent bone. Legs 18 are expanded in response to engagement with asetting pin 24 as described below.

Setting pin 24 is part of expandable tissue fastener 10 and includes anelongated shaft 26 with at least one, and preferably four, lengthwiseextending fins 28 adapted to engage and be guided by slots 20 in body12. A series of circumferential barbs 30 on the shaft 26 inhibit distalmotion of setting pin 14 relative to body 12. Shaft 24 also includes awider diameter head 32 at its proximal end to facilitate grasping ofsetting pin 24 by an implantation instrument. At its distal end portion,shaft 26 includes an expanded diameter bulbous portion 34 which includesa proximally facing camming surface 36 and distally facing beveled tip38. Camming surface 36 is provided to engage and radially expand legs 18on body 12. A first end 42 of an associated length of suture 40 isaffixed to shaft 26 within a bore 44 in tip 38. A needle 46 is affixedto a second end 48 of suture 40. Needle 46 may be a known suturingneedle or, preferably, a surgical incision member such as that disclosedin U.S. Pat. No. 5,569,301 to Granger et al., the entire disclosure ofwhich is incorporated by reference herein. A transverse bore 50 forreceipt of suture 40 is provided in bulbous portion 38. Shaft 26 alsoincludes a proximal end portion demarcated by a circumferentialbreakaway notch 52.

A mounting member 100 is provided to mount tissue fastener 10 on animplantation apparatus and together therewith forms a disposable loadingunit 150. Mounting member 100 is a tissue fastener mounting portionwhich is an independent structure for supporting both expandable body 12of tissue fastener 10 and setting pin 24. The entire disposable loadingunit 150 mounts to the distal end of the implantation apparatus, asdescribed below.

Mounting member 100 includes a collar 102 defining a recess 104 intowhich head 16 of body 12 is received and supported. A shaft 106 definesa lengthwise axis and includes laterally extending bayonet mounting pins108 for releasably engaging L-shaped slots in the housing tube of animplantation instrument. A mounting slot 110 for retaining setting pin24 extends lengthwise through collar 102 and includes at least oneabutment wall 112 for contacting and retaining head 32 of setting pin24. An access port 114 enables head 32 to be mounted into mounting slot110 proximal to abutment wall 112. Mounting member 100 also includesarcuate lengthwise extending access chambers 116 which allow passagetherethrough of pusher prongs (discussed below) for contacting andpushing head 16 of body 12.

Referring to FIGS. 2 and 3, shaft 26 of setting pin 24 is adapted to beslidably disposed within aperture 15 of body 12. When body 12 is moveddistally with respect to setting pin 24, camming surface 36 eventuallycontacts the distal tips of legs 18. Further distal movement of body 12causes legs 18 to splay radially apart under the camming action ofsurface 36 because the diameter of bulbous portion 34 is greater thanthat of aperture 15. Distal movement of body 12 can be effected by aninstrument which distally advances body 12 while holding setting pin 24stationary, or which grips and pulls head 32 of setting pin 24 whileholding body 12 stationary. At a predetermined point, legs 18 are fullyexpanded and the setting pin 24 cannot move any further through aperture15. Increased pulling force applied to the proximal end portion of shaft26 causes shaft 26 to fracture at breakaway notch 52 thereby splittingoff the proximal end portion shaft 26 when a predetermined force isapplied. Setting pin 24 is configured and dimensioned such that whensetting pin shaft 26 undergoes the controlled fracture at full expansionof legs 18, breakaway notch 52 will not be positioned outside aperture15 of the body 12 but rather within aperture 15.

Referring now to FIG. 4, disposable loading unit 150 is provided to thesurgeon in sterilized form and may arrive fully assembled with tissuefastener 10 positioned in mounting member 100 or the components may beseparated requiring assembly.

In order to assemble tissue fastener 10 within mounting member 100,elongated shaft 26 of setting pin 24 is inserted into keyhole shapedmounting slot 110 in mounting member 100. Elongated shaft 26 is advancedwithin slot 110 until head 32 is flexed to a position down into slot 110and abuts abutment wall 112. Thus, head 16 of expandable body 12 ispositioned within recess 104 in collar 102. In this manner thedisposable loading unit is assembled and is ready for insertion into animplantation instrument. Attached suture 40 and needle 46 may beprovided loose or may be provided in a separate loading unit tofacilitate loading needle 46 into a surgical suturing instrument.

Referring now to FIG. 5, there is disclosed a suitable tissue fastenerimplantation apparatus 200, the components and operation of which aremore fully described in U.S. Pat. No. 5,928,244 to Tovey et al., theentire disclosure of which is incorporated by reference herein. Ingeneral, implantation apparatus 200 includes an elongated portion 202extending distally from a handle portion 204. Handle portion 204generally includes a stationary handle portion 206 and a trigger 208.Operation of trigger 208 acts as operating structure to expand tissuefastener 10.

A distal end of elongated portion 202 is provided with an L-shaped slot210 configured to receive bayonet mounting pins 108 of mounting member100. In order to assemble on disposable loading unit 150 intoimplantation apparatus 200, mounting member 100 is positioned andadvanced into the distal end of elongated member 202 such that bayonetmounting pins 108 enter elongated slot 210. Mounting member 100 is thenrotated such that bayonet pins 108 are rotated into the transverseportion 212 of slot 210. Thus, the disposable loading unit 150 includingmounting member 100 and tissue fastener 10 are securely attached to thedistal end of implantation apparatus 200. As noted above, operation oftrigger will drive expandable body 12 distally relative to setting pin24 to thereby expand legs 18 radially outward.

As noted hereinabove, tissue fastener 10 includes a length of suture 40and a needle 46. Needle 46 may be of any suitable tissue suturingvariety. However, the preferred needle 46 is a surgical incision member46 of the type noted in U.S. Pat. No. 5,569,301 the contents of whichwere incorporated by reference hereinabove. When utilizing surgicalincision member 46, the use of a particular suturing apparatus disclosedin U.S. Pat. No. 5,569,301 is advantageous. Suturing apparatus 250generally includes a handle portion 252 having a pair of pivotinghandles 254 affixed thereto. An elongated member 256 extends distallyfrom handle portion 252 and terminates in a pair of movable jaws 258 and260. Actuation of handles 254 opens and closes jaws 258 and 260. Asdiscussed in U.S. Pat. No. 5,569,301, operation of a toggle lever 262functions to releasably and alternatively secure surgical incisionmember 46 within jaws 258 and 260. Thus, by closing handles 254, jaws258 and 260 close and cause surgical incision 46 to penetrate tissuepositioned therebetween, upon operation of toggle lever 262, surgicalincision member 46 can be released from a first jaw and secured in asecond jaw to thereby pass the needle through tissue upon opening ofjaws 258, 260.

Referring now to FIG. 6, the use of tissue fastener 10 to secure a pieceof tissue such as muscle tissue relative to bone will now be described.While this discussion has broad applicability to any situation wheremuscle tissue, ligaments or other soft tissue are to be secured to bone,the following discussion is in terms of securing tissue adjacent a boredrilled in bone as in typical shoulder surgeries. As shown in FIG. 6,the suturing apparatus has been operated to pass surgical incisionmember 46 and a portion of associated length of suture 40 through atissue section A. As more fully discussed in U.S. Pat. No. 5,569,301,this is accomplished by positioning the surgical incision member in jaw258, operating suturing apparatus 250 to close jaws 258 and 260 togetherso as to pierce tissue section A with surgical incision member 46 andactuating the surgical suturing instrument so as to release surgicalincision member 46 from upper jaw 258 and securely grasping it in lowerjaw 260, thus on opening of jaws 258 and 260 surgical incision member 46and portion of suture 40 is pulled through tissue section A.

Referring now to FIG. 7, in order to secure tissue section A to distalend of setting pin 24, suturing apparatus 250 is again operated so as topass surgical incision member 46 through bore transverse 50 in bulbousportion 34 of setting pin 24. By manipulating surgical suturingapparatus 250, tension may be applied to suture 40 so as to draw tissuesection A tightly against the distal end of setting pin 24.

Referring now to FIG. 8, in order to secure and draw a tissue sectionadjacent a particular section of bone, a bore B is drilled in thedesired section of shoulder bone C. Once a bore B has been drilled inbone C, implantation apparatus 200 can be manipulated so as to positionthe unfired tissue fastener 10 having a length of tissue A securedadjacent to it within bore B.

Referring to FIGS. 8-10, actuation of implantation apparatus 200 drivesa pair of pusher prongs 212 through access chamber 116 in mountingmember 100 to engage bead 16 of expandable member 12 and thus driveexpandable member 12 distally relative to setting 24. Mounting member100 may have access chamber 116 tapered toward the center of member 100to allow use with existing instrumentation and engage the relativelysmall diameter head 16 of expandable member 12. As noted hereinabove,when tissue fastener 10 is loaded in mounting member 100, head 32 ofsetting pin 24 is restrained from movement. Thus, as the prongs driveexpandable member 12 distally, the distal ends of legs 18 are engaged bycamming surface 36 on setting pin 24 and driven radially outwardly. Asnoted above, fins 28 are engaged and are guided by slots 20 formed inexpandable member 12. As legs 18 are driven radially outward, barbs 22engage and secure a portion of suture 40 against the bone C within boreB. Alternatively tissue section A may be drawn into bore B prior toexpanding expandable member 12. As discussed above, when sufficientforce has been applied to expandable member 12 by pusher prongs,expandable member 12 can advance no further relative to setting pin 24and the additional force severs or breaks setting pin 24 at breakawaynotch 52.

As shown in FIG. 9, after actuation, setting pin 24 is disposed inwardlyof head 16 of expandable member 12. In this manner, the section oftissue A is secured adjacent the opening of the bore in bone C. Thesuture 40 will be sufficiently tensioned so that the tissue section Aremains outside the bore. Thus tension can be provided to suture 40 soas to snug an extreme end of the tissue section adjacent tissue fastener10 without drawing it down into the bore. Actuation of the expandablemember 12 secures and locks the suture in place within bore B therebyfacilitating securement of the tissue section without the need for anyexternal knots. Thus, this is a convenient, secure and easy knotlesssuture securing procedure.

Referring now to FIG. 11, the use of tissue fastener 10 in knee ligamentrepair surgery where it is desirable to secure a distal end of aligament within an elongated bore drilled in a knee bone will now bedescribed. As noted above, often this is accomplished by threading ascrew adjacent the ligament thereby abrading the ligament or by wedgingthe ligament together with some sort of wedge into the bore in whichevent the ligament must travel a longitudinal distance while beingabraded by bone on one side and the wedge on the other. The disclosedmethod has the distinct advantage of being able to position a ligamentsection within a bore in a knee bone without any trauma to the ligament.

As shown in FIG. 11, initially surgical suturing apparatus 250 isactuated and so as to pass surgical incision member 46 and thus suture40 through ligament section D. Preferably, surgical incision member 46is passed back and forth through ligament section D several times so asto gain a secure hold of ligament D with suture 40.

Referring now to FIG. 12, ligament section D is advanced along suture 40towards beveled tip 38 until the pierced section of ligament D isadjacent beveled tip 38. Thereafter, in order to firmly secure ligamentsection D to setting pin 24 the suturing apparatus is actuated to passsurgical incision 46 through transverse bore 50 in setting pin 24. Thesuture may then be wrapped around bulbous portion 34 and ligament Dnumerous times to thereby lash ligament D to the distal end of settingpin 24.

Subsequently, disposable loading unit 150 containing the attachedligament D is mounted to the implant apparatus as described above.

Referring now to FIG. 13, once disposable loading unit 100 and apparatus200 have been assembled, implantation apparatus 200 is positioned suchthat elongated portion 202 and issue fastener 10 are advanced throughbores E and F drilled through knee joints G and H. Specifically shown inFIG. 13, bores E and F through the knee bone sections are of sufficientdiameter such that elongated portion 204 may be passed therethrough.However, because of the reduced diameter of tissue fastener 10 andligament D, the ligament is not traumatized as it is advanced throughbones E and F. A smaller diameter bore 1 is drilled at the end of bore Fto accommodate them. The point at which the implant is to be expanded isin the reduced diameter bore 1.

Referring to FIGS. 13 and 14, actuation of implantation apparatus 200will operate to push expandable member 12 distally relative to settingpin 24 thereby forcing legs 18 radially outwardly to engage and secureligament section D adjacent to bone G. Thus, ligament D is firmlysecured within bore F in sutureless fashion without trauma to ligament Dand no additional knots need be tied.

It will be understood that various modifications may be made to theembodiments disclosed herein. For example, barbs 22 are an expandablemember 12 may be reconfigured as abraded surfaces or other means tofrictionally engage suture 12 when cammed against suture 12 in a bore inbone. Additionally, barbs 22 may assume a rounded configuration to beless traumatic to any associated ligament or tissue section engaged bylegs 18 as they expand. The above description should not be construed aslimiting, but merely as exemplifications of preferred embodiments andmethods. Those skilled in the art will envision other modifications anduses within the scope and spirit of the claims appended hereto.

1-21. (canceled)
 22. A knotless tissue anchor comprising: an expandablemember defining a bore therethrough and including a shaft and a radiallyexpandable portion extending distally from the shaft; an inner memberhaving a conical leading tip at a distal end thereof and slidablydisposed within the bore of the expandable member such that theexpandable portion expands radially outwardly in response tolongitudinal motion of the expandable member relative to the innermember; and a length of suture having a first end and a second end, thefirst end of the suture being affixed to the distal end of the innermember.
 23. The knotless tissue anchor as recited in claim 22, whereinthe expandable portion includes at least two flexible legs.
 24. Theknotless tissue anchor as recited in claim 23, wherein the inner memberhas a camming surface configured to engage the at least two flexiblelegs to force ends of said legs radially outward in response to relativelongitudinal motion between the expandable member and the inner member.25. The knotless tissue anchor as recited in claim 24, wherein thecamming surface engages the at least two legs in response to distalmovement of the expandable member relative to the inner member.
 26. Theknotless tissue anchor as recited in claim 22, wherein a distal portionof the inner member defines a transverse bore therethrough for receiptof the length of suture.
 27. The knotless tissue anchor as recited inclaim 22, further comprising a needle affixed to the second end of thesuture.
 28. The knotless tissue anchor as recited in claim 27, whereinthe needle is a double pointed incision member and the second end of thesuture is affixed to the needle intermediate the points.
 29. A knotlesstissue anchor comprising: an expandable member defining a boretherethrough and including a shaft and a radially expandable portionextending distally from the shaft; an inner member slidably disposedwithin the bore of the expandable member such that the expandableportion expands radially outwardly in response to longitudinal motion ofthe expandable member relative to the inner member; and a length ofsuture having a first end and a second end, the first end of the suturebeing affixed to the distal end of the inner member, wherein the lengthof suture extends from a distal end of the inner member and externallyof the expandable member.
 30. The knotless tissue anchor as recited inclaim 29, wherein the inner member has circumferential ridges, theridges engageable with the expandable member to prevent distal motion ofthe inner member relative to the expandable member after the expandableportion has been radially expanded.
 31. The knotless tissue anchor asrecited in claim 29, wherein the at least two expandable legs haveridges on outer surfaces thereof to frictionally engage surroundingbone.
 32. The knotless tissue anchor as recited in claim 29, wherein theexpandable member has an enlarged head at a proximal end thereof. 33.The knotless tissue anchor as recited in claim 29, wherein the length ofsuture extends from the distal end of the inner member and externally ofthe expandable member.